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Service Learning
The World as the Classroom
By Michelle Vanderhoff
Interest in service learning is surging. How are educators
balancing the needs and expectations of students, patients, educational
institutions, communities, and the profession?
Kelly Braden, PT, DPT, then a student at Virginia Commonwealth
University (VCU) in Richmond, participated in a service learning project
last year, neither she nor Dianne Jewell, PT, PhD, CCS, FAACVPR, an
assistant professor in VCU's Department of Physical Therapy, realized
just how far-both figuratively and literally-the project would take
her.
VCU offers its DPT students a variety of service learning (SL)
opportunities. One--an annual prosthetic limb and brace drive--last year
collected more than $80,000 of in-kind donations that were distributed
internationally for use by individuals who were injured by land mines or
have experienced traumatic amputations. The VCU role was to collect the
limbs and turn them over to the not-for-profit Physicians for Peace and
its "Walking Free" program.
But, Jewell explains, "Kelly took that experience and extended it by
traveling with Physicians for Peace to the Dominican Republic this past
summer. She raised the funds to go there and got in touch with people
there for a place to stay. She ended up staying for an entire month,
working with physical therapists (PTs) and prosthetists. She even
participated in physical therapy classes at La Universidad Catolica.
That was under her own initiative. What that says to us is that she got
the message about service, saw the opportunity to give of herself, and
acted on it." Braden confirms that conclusion, stating, "While I hope
that I was able to leave the people I met with new ideas and techniques,
I am sure that I gained far more than I was able to give."
Why Service Learning?
According to Johnette L Meadows, PT, MS, director of APTA's
Department of Minority/International Affairs, the growth in the number
of service learning programs has been spurred by many universities
recognizing specific needs of the patient/client population surrounding
them. These needs often are based on linguistic and cultural
differences, but, as Jewell notes, they also may reflect differences in
age; socioeconomic status; lifestyle, such as drug addiction; or life
circumstances, such as homelessness.
| Service Learning Gaining in
Popularity |
According to the National Service-Learning
Clearinghouse:1
- Almost 30% of the 6.7 million students in public and private 4 year
institutions of higher education report participating in a course where
service is part of the curriculum.
- Almost 2 million students participate in service learning at 4 year
public and private institutions.
- Almost half of all community colleges in the United States offer
service learning courses.
This growth may be an extension of a boom in the growth of service
learning at the high school level. According to the Clearinghouse, from
1984 to 1997:1
- The number of high school students involved in service related
programs rose from 900,000 to 6,181,797, an increase of 686%.
- The number of high school students involved in service learning grew
from 81,000 students to 2,967,262 students, a 3,663% increase.
A recent study examined the use of service learning, extracurricular
volunteer activity, and pro bono services within physical therapist (PT)
and physical therapist assistant (PTA) education.2
Surveys were sent to all accredited PT and PTA programs. The response
rate was 48% and 47% for the PT and PTA programs, respectively.
Within the past 7 years, 77% of the PT and 61% of the PTA programs
had at least one of the three types of service activities. Of the
respondents, 50 PT programs and 38 PTA programs currently were using
service learning in their curricula. The most common service activity
being implemented by PT programs was service learning, while for PTA
programs volunteer activity was more common.
The study found, "Half of those responding to this survey incorporate
some form of community-based learning within their curriculum and many
programs where it is not yet included are planning to add service
learning. Service-learning and pro bono services are offered more
frequently in PT than in PTA programs. This study suggests that physical
therapy education is increasingly incorporating service
opportunities."
_____________
1. Shumer R, Cook C. The status of service-learning in the United
States: some facts and figures. National Service-Learning Clearinghouse;
1999. Available at www.servicelearning.org/
resources/online_documents/research/
the_status_of_service-learning_in_the_united_states_some_f
acts_and_figures/index.php. Accessed March 10, 2005.
2. Village D, Clouten N, Millar AL. Comparison of the use of
service-learning, volunteerism, and pro bono activities in physical
therapy curriculum. A paper presented at PT 2004, Chicago, IL, June
2004.
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Other factors have been offered as further justification for service
learning programs. First is the increasingly common view that SL can
provide a better learning experience than does the traditional
classroom. In "Service Learning: Designing and Implementing a Successful
Program," a paper summarizing their service learning experiences, a
group of Northeastern University students suggest that universities are
tapping into the student population as a resource to help provide
community education and thus address a goal of Healthy People
2010.1
Jewell agrees but also sees student motivation as a key factor in the
increasing popularity of SL programs. "The students really want to do
this," she says. The current generation of PT students, she says, is
enthusiastic about community service and not only willingly participates
in a class with a service learning component, but even comes to her with
new, self-initiated projects.
Ann Naumann, PT, MS, OCS, clinical assistant professor in the
Department of Physical Therapy at the University of Vermont, says that
PTs also "have an obligation to the community." This element seems to
have long-lasting effects. Sandra Levi, PT, PhD, formerly on the faculty
at the University of Illinois at Chicago Physical Therapy Program, says
a significant number of her graduates remain actively involved in
volunteer or pro bono work in their respective communities.
Jewell agrees, describing a recent DPT graduate who participated in
service learning as a student. After graduation, she became employed as
a physical therapist in Richmond. Jewell picks up the story: "On her
own, she talked to her employer and said she'd like to volunteer at one
of our service learning sites, the Cross Over Health Center, a free
health clinic for the uninsured working poor, the working homeless, and
the unemployed homeless. Her employer said yes. So now she's part of our
volunteer staff and comes over every Friday afternoon."
Meeting Student and Community Needs
Service learning programs vary widely in regard to community needs,
curricular structure, setting, patient population, and stated
educational objectives. But the most important element, according to
those interviewed for this article, is the answer to the question: "What
do my students need?"
Naumann says that students learn things they can't get from a typical
classroom experience. These include the functions of community agencies,
exposure to new patient populations, and working with interdisciplinary
staff. One advantage, Naumann's students tell her, is that a service
learning environment offers a way to practice their skills without the
pressure sometimes associated with a formal clinical experience. They
get to "see dystonia, feel spasticity," she says, but they also learn
that "elders are interesting people."
Jewell gives another example: "Students at our foot clinic, which
specifically targets individuals who are homeless, see patients who they
wouldn't see during their routine education. That's a great opportunity
to learn additional compassion and openness."
Although benefits to students are great, reciprocity is a key element
in service learning. Students must put in as much as they get out of the
experience, and patients must benefit as much as students. After all,
the goal is to provide high-quality patient care.
And there can be still other benefits. Jewell adds, "For students who do
have a faith-based connection in their lives, the foot clinic has
enormous spiritual meaning. We don't talk about that, but we can't
ignore the cultural impacts on the students any more than we can on the
patients."
An Evolving Concept
Education programs for PT and physical therapist assistant (PTA)
students are evolving to keep up with the profession's changing needs.
In the past several years, there's been a "growth spurt" in the
development of service learning programs. One recent survey of
accredited PT and PTA programs found that half have incorporated some
form of community-based learning within their curriculum. (See "Service
Learning Gaining in Popularity.")
| Cultural Competence in Service Learning |
| While service learning is not a formal accreditation requirement,
certain professional practice expectations--such as altruism and
cultural competency--can be met by participating in a service learning
program, according to Mary Jane Harris, PT, MS, director of APTA's
Department of Accreditation. In Professional Practice Expectation 2.1 in
A Normative Model for Physical Therapist Practice: Version 2004, one of
the educational outcomes of altruism states that a graduate "recognizes
the need for physical therapy services to underserved and
underrepresented populations."1 Section 2.2 covers pro bono
services.
Professional Practice Expectation 7 addresses cultural competence. It
states, in part, that a successful graduate "incorporates an
understanding of the implications of individual and cultural differences
in the management and delivery of physical therapy services" and also
"is aware of and suspends [his or her] own social and cultural
biases."1 In addition, APTA's Professionalism in Physical
Therapy: Core Values includes altruism, compassion/caring, and social
responsibility as essential qualities of a PT.
Gail Jensen, PT, PhD, is associate dean of faculty development and
assessment at Creighton University, which partners with the Omaha and
Winnebago Nations in a project called Circles of Learning: Community and
Clinic as Interdisciplinary Classroom. PT students in the program work
in a clinical hospital on a reservation for 4 weeks. This immersion
program has shown her that there is "an awareness of self" when one is
physically in another culture "that you can't get from didactic
work."
While service learning is an important tool in enhancing students'
cultural competency, it must be interwoven into instruction. As Johnette
L Meadows, PT, MS, director of APTA's Department of
Minority/International Affairs, puts it, "Health comes first-ethnicity
is just another aspect to consider" when treating a patient. In other
words, students shouldn't ignore a patient's ethnicity, language
barrier, socioeconomic status, or any other personal circumstances. On
the other hand, they should be taught not to make it their main focus of
attention, either.
One goal of some service learning programs is to break down
stereotypes. However, studies of physical therapy service learning
programs have shown that, instead, stereotypes inadvertently actually
can be reinforced. A recent study by Janna Beling, PT, PhD, found that
PT students held more negative bias about aging after an SL program, and
that an increase in knowledge does not always "lead to changes in
attitudes and can have negative effects."2 Meadows advises
that this may be avoided by making sure students go through a
"preorientation" period before beginning a service learning program.
During a preorientation, students should learn such things as:
- What is cultural competency?
- Why do I need to understand it?
- Health comes first-cultural competency is just a part of what we
do.
- Don't stereotype; treat people on an individual basis.
- How do people from different cultures or lifestyles view
disease/impairment?
- How do they talk about it?
- How do they deal with it?
1. A Normative Model of Physical Therapist Professional Education:
Version 2004. Alexandria, Va: American Physical Therapy Association;
2004.
2. Beling J. Impact of service learning on physical therapist knowledge
of and attitudes toward older adults and on their critical thinking
ability. J Phys Ther Educ. 2004;18(1):13-21. |
In broad terms, service learning programs combine community service and
academic study for a richer learning experience. In general, there are
four basic models for service learning programs. An SL program may:
- emphasize learning over service,
- emphasize service over learning,
- incorporate both service and learning but with no formal
relationship between them, or
- balance both, with a community-educator partnership in the planning
stage.2
There is some debate about which model is most appropriate and how to
balance community service and education. For example, Jewell describes
SL as "giving students the opportunity of providing service to others,"
while tying in learning objectives and a class project for professional
development. Community-Campus Partnerships for Health,3 a nonprofit
organization that promotes health through partnerships between
communities and higher education institution, defines it as "a
structured learning experience that combines community service with
preparation and reflection" with a balance between service and learning,
combining "community service" or "volunteerism" with either "field
education" or a "practicum," such as an internship.
Despite the multiple definitions of what service learning is, those
interviewed for this article clearly agreed on what service learning is
not: It is not a volunteer program; it is not community service hours
required for graduation; it is not a form of punishment; and it does not
just benefit either the student or the community.
The process of developing a new program or modifying an existing one
involves active dialogue to determine appropriate goals for both
students and the community agency. Staff at the site may not be overly
enthusiastic. Nurses, OTs, and other staff may be short on budget,
manpower, time, or all three, and may worry that the students will take
them away from their primary duties. The solution is for the advisor to
take the time to talk with the staff, hear their concerns, and allay
their fears.
Other advice from those interviewed for this article:
- Plan upfront.
- Talk to people who already have been through the process. They can
tell you how to avoid pitfalls.
- Partner at all levels, not just at the administrative level, but in
the trenches.
- Determine clear learning and service objectives.
- Keep an open mind to experience and be flexible.
Developing Criteria for Success
There is ongoing debate over the practical implementation of a
program and how to maintain a balanced focus on both academic content
and community service. According to Judith H Munter, PhD, in Academic
Exchange Quarterly, "it is easy for programs to slip down one slope
or another from this pinnacle--either becoming strictly volunteer
service endeavors...or becoming internship and laboratory opportunities
for students"4 without integrating the two into one rich experience.
This is why collaboration between community partner and university
program is paramount to success.
The common elements of a service learning program include service
objectives, learning objectives, learning strategies, assessment, and
criteria for evaluation of outcomes. Some universities are developing
concrete criteria for their own programs. The University of Vermont has
an Office of Community-University Partnerships and Service-Learning
(CUPS) that developed university-wide criteria for all of its SL
programs. These criteria include: 1) a credit-bearing course; 2)
integration of academic content and service in the course design; 3)
planned reciprocity between community partner and students; 4) student
assessment and credit based upon demonstration of learning, including
critical reflection regarding integration of service and academic
content; and 5) active guidance to the students in critical
reflection.5
According to Pamela Reynolds, PT, EdD, GCS, of Gannon University
(formerly of Chatham College), "intentional goals" and "reciprocity" are
"two factors that distinguish service learning experiences from other
types of community service programs."6 The educational objectives she
used for her program at Chatham College included developing social
responsibility, citizenship, and advocacy; developing a perception and
understanding of health and illness and the variety of meanings these
terms carry for individuals and members of differing groups;
demonstrating cultural competence when gathering data for the
patient/client history examination related to cultural beliefs and
behaviors; and understanding and considering individual and cultural
difference in development of prognosis and interventions.7 Objectives
from other programs include intellectual development and development of
moral reasoning.8
Varying Beginnings and Approaches
Programs can vary in terms of their origins, types of collaborations,
and evaluation, among other things.
Origins and funding. Creighton's Circles of Learning is funded
by a grant from the US Department of Health and Human Services and is a
cooperative effort between the University and the Omaha and Winnebago
Nations. Levi's course was developed using a grant from the US
Department of Health and Human Services' Health Resources and Services
Administration, with the actual program using a public health model. VCU
DPT students, in conjunction with Hanger Orthotics, sponsored the limb
and brace drive, with the donated devices delivered to the
not-for-profit Physicians for Peace. Some students at VCU have been
involved in developing service learning programs.
Degree and type of collaboration. In some instances, the
school decides what kind of program or clinic it wants to have, and then
it looks for an agency with whom to partner. Other times, existing
agency programs may need help and search out a school willing to
collaborate with them. Students sometimes are brought into the planning
process after the initial meetings between the agency and school. Levi's
program was limited to a small group of students who developed their own
projects and went out in teams of physical therapy, occupational
therapy, and nutrition science students, partnering with a clinic or
assisted living facility, for example.
Grading and evaluation. The culmination of the student
experience is assessment, evaluation, and grading. This is also an area
of diverse opinions. Student assessment and evaluation can be
accomplished through quizzes, surveys, oral reports, outcome data,
written self-reflection, and/or site evaluation by the advisor, along
with student evaluation of practicum. It also can be a group project in
which students may carry out a program from design through evaluation.
There are many models, but the key is that the student demonstrate that
he or she has learned and can apply that learning to a real work
situation.
| Additional Resources |
Break Away
An organization whose mission is to train, assist, and connect campuses
and communities in promoting quality alternative break programs that
inspire lifelong active citizenship.
www.alternativebreaks.com
Community-Campus Partnerships for Health
A non-profit organization that fosters partnerships between communities
and higher educational institutions.
http://futurehealth.ucsf.edu/ccph.html
Educators for Community Engagement
A national organization dedicated to democratizing classrooms and
communities through learning circles, service learning, and critical
dialogue.
www.e4ce.org
The Michigan Journal of Community Service Learning
A national, peer-reviewed journal consisting of articles written by
faculty and service-learning educators on research, theory, pedagogy,
and issues pertinent to the service-learning community.
www.umich.edu/~mjcsl/main.html
National Service Learning Clearinghouse
www.servicelearning.org
National Society for Experiential Education
A national resource center that promotes experience-based approaches to
teaching and learning.
www.nsee.org
Professionalism in Physical Therapy: Core Values
www.apta.org/ documents/public/ education/professionalism.pdf
|
In VCU's DPT program, students are required to complete a portfolio
project and write their reflections on the nature of the activity, why
they chose it, what they learned, and how it may affect them as a
professional. Naumann says the University of Vermont students are graded
on what they produce academically, not on the services they provide.
This includes developing a plan of treatment for a resident of a senior
citizen housing agency, identifying the patients' health concerns, and
producing written reflection, which is "actively guided" by faculty.
Creighton's Circles program relies on both quantitative and
qualitative methods to measure student progress. This includes adapted
surveys, team-building scales, and reflective journals. Gail Jensen, PT,
PhD, associate dean of faculty development and assessment at Creighton
University, says that both types of assessments are important for
evaluating the student and the program: Quantitative measures "make sure
you know what students are and are not learning" and therefore can help
adapt a program or teaching style to meet course objectives.
Not a Hard Sell
Some programs include service learning as an entire course; others
have a service learning component to a course. Some are elective, and
some are part of the required coursework to graduate.
In fact, a subject of continuing debate is whether to make service
learning a compulsory element of all PT education programs. Proponents
argue that it exposes all students to service learning experience and
also meets criteria defined in the Guide to Physical Therapist Practice.
Opponents assert that students who freely choose to participate bring a
spirit of service that could be lost if "service" is made a requirement.
If it is required, Naumann suggests, there should be room for student
choice in the type of service learning program in which they can
participate, because "when it is student-driven, there is a different
feeling" than if it is required in order to graduate.
VCU doesn't require a minimum number of hours of service learning,
although Jewell acknowledges that "As we're looking at how the DPT is
working, service learning, including minimum thresholds, will continue
to be evaluated." However, she offers this encouragement for
institutions considering service learning: "[It] would not be difficult
for any program to include. Students are really jazzed about it. The
actual opportunity to serve is not a hard sell."
There's another lesson that Jewell says both she and her students
have learned. "When you're young," she explains, "you have a desire to
change the world. You worry about all the people not getting care. But
because of our ongoing programs and the one-on-one contact with patients
and clients, you learn you don't have to change the world to make a
difference. You can make a difference with that one person sitting in
front of you."
_______________
Michelle Vanderhoff is editor and project manager in APTA's
publications department.
References
1. DiNoble K, Dyka E, Moreau M, Wilson K. "Service Learning: A Guide
to Designing and Implementing a Successful Program." Boston, Mass:
Northeastern University; 2004.
2. Sigmon RL. Linking Service With Learning. Washington, DC:
Council of Independent Colleges; 1994.
3. Community-Campus Partnerships for Health Web site. Available
at: http://depts.washington.edu/ccph/servicelearningres.html.
Accessed December 17, 2004.
4. Munter JH. We have been delighted [editorial]. Academic Exchange
Quarterly [serial online]. 2000:4(4);2. Available at: www.rapidintellect.com/AEQweb/wi2000.htm. Accessed
December 17, 2004.
5. Criteria for Designation of Service-Learning Courses at UVM.
Community-University Partnerships and Service-Learning (CUPS) Web page.
University of Vermont Web site. Available at: www.uvm.edu/~partners/?Page=SLForm.php. Accessed
February 14, 2005.
6. Reynolds P. How service learning experiences benefit physical therapy
students' professional development: A grounded theory study
[dissertation]. Pittsburgh, Pa: Duquesne University; 2000. AAT 9993768.
UMI ProQuest Digital Dissertations Web site. Available at: www.lib.umi.com/dissertations/preview/9993768.
Accessed February 14, 2005.
7. Reynolds P. Syllabus for PTH 738: Service Experience Project
[Community-Campus Partnerships for Health Web site]. Available
at: http://depts.washington.edu/ccph/pdf_files/PTsyllabus.pdf.
Accessed February 14, 2005.
8. Alt M, Medrich E. Students' outcomes from participation in
community service. Paper presented at the meeting of the US
Department of Education Office of Research. 1994.
PT Magazine - May 2005
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